ERCP (Endoscopic Retrograde Cholangio-Pancreatography)
What is ERCP?
ERCP is a technique that combines endoscopy and fluoroscopy to diagnose and to treat biliary or pancreatic ductal diseases. Here, an endoscope is inserted through the mouth down into the duodenum.
The endoscope has a small camera at the tip of it. This is a special endoscope which has a working channel by the side of it, through which dye is passed and it lines and highlights the whole bile duct. It can be used to diagnose and treat the pathology of whole biliary tract. The instruments can be passed through the working channel to get the obstruction relieved, or stone removed.
Indications of ERCP/ Where is ERCP needed?
• Gallstones in the bile duct
• Obstructive Jaundice – when there is an obstruction in free flow of bile either due to stone, or stricture or cancer. ERCP can be done to relieve this obstruction.
[However, it is a difficult procedure. Hence it is very important that it is done by highly experienced personnel.]
• Suspected disease/ cancer of biliary or pancreatic duct pathway.
• Pancreatitis of unknown cause
• Stenting for strictures/ cancerous blockage of duct
• Unexplained loss of appetite and weight los
• Drainage of pancreatic pseudocyst
• Chronic pancreatitis
• Biliary parasites
How is ERCP done?
ERCP is mainly done for therapeutic purposes. Here, the patient usually receives i.v. sedation or general anesthesia. The endoscope is then passed from the mouth, going to the stomach through the esophagus, and up to the small intestine. The small intestines have very minute openings from the gall bladder duct, called CBD (Common Bile Duct) and pancreatic duct (PD) opening. Once identified, these may be negotiated, catheter passed through either of them depending on suspected pathology. Then dye is pushed through the catheter and x- ray images are taken.
If there are stones in common bile duct or pancreatic duct, they are pulled through specialized instruments and removed. If there is a stricture, i.e., tight opening, then a stent is passed through to ensure free flow of bile through the duct. Here, there may or may not be need of sphincterotomy, cutting the sphincter. In case of cancer, compressing the ducts, stent can be passed through for smooth functioning till the surgery is planned or chemotherapy is given.
It usually takes 30- 60 minutes to perform ERCP completely.
Q. How to prepare for ERCP? What to do before ERCP?
• Donot eat or drink anything 8 hours before undergoing ERCP
• Dress comfortably
• Come with an attendant to arrange for a ride back home, due to effects of sedation
• You may need to stay in hospital for the next 1-2 hours depending on the procedure performed. However, you may be asked to stay for a day too.
• If you have any co-morbidities (like hypertension, diabetes, heart condition or bleeding disorder, do inform doctor beforehand). If you are consuming any chronic medicines, then they need to be reviewed weather to continue or not before the procedure.
IMPORTANT Frequently Asked Questions
Q. What can I expect after undergoing ERCP?
A. You will be observed for a few hours post- procedure. You can expect temporary soreness in your throat. Lozenges may help. However, this discomfort is pretty minor.
Occasionally, you may experience a mild sour throat after ERCP. This will respond well to saline gargles. You may also have a feeling of distention from the air that was used during the procedure which will be short lasted and self-limiting.
Q. What to eat after ERCP?
A. Clear fluids are allowed after discussion with the physician, approximately 12 hours after the procedure. You may start light diet, once the swallowing becomes normal.
Q. Are there any risks involved in ERCP?
A. Although ERCP is a safe process, but Some of the complications of ERCP are-
• Infection of the bile ducts (Cholangitis)
• Acute Pancreatitis
• Injury/ perforation to bile duct/ pancreatic duct
• Excess Bleeding
• Aspiration or adverse reaction to anesthesia or sedation.
Q. Is there any pain during/ after ERCP?
A. The ERCP is done under sedation or GA, so there is no pain during procedure. However, after the procedure, you may feel some pain due to bowel distension and inflate air or spasms.
Q. Danger signs after ERCP
A. One should be alert of following danger signs and report to doctor/ Emergency immediately if they are experiencing any of the below signs after ERCP
• Chest Pain
• Difficulty in breathing
• Severe Pain upper abdomen
• Passing black/ tarry stool
• Persistent vomiting
This information is intended only to provide general guidance and not an alternative for formal doctor advice. It is very important that you consult your doctor about your specific condition